Discharge summary and Summary Statement
Topic 8 Discharge Summary Template
Directions: Complete the Discharge Summary form by addressing the fields below.
Presenting Problem Upon Admission:
[State the client's presenting problem upon admission here.]
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Client Name: [Enter the client's name here] |
Date of Birth: [MM/DD/YYYY] |
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Date of Admission: [MM/DD/YYYY] |
Date of Discharge: [MM/DD/YYYY] |
Current Medication:
[List the client's current medications here.]
Reason for Discharge:
[State the client's reason for discharge here.]
Resources and Referrals:
[List the client's resources and referrals here.]
Projected Prognosis:
[State the client's projected prognosis here.]
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Eliza D 00/00/00 |
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<sign and date here> |
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Client Signature & Date |
Case Manager Signature & Date |
© 2017. Grand Canyon University. All Rights Reserved.
© 2017. Grand Canyon University. All Rights Reserved.